Carbamazepine hypersensitivity syndrome triggered by a human herpes virus reactivation in a genetically predisposed patient

Lorenzo Calligaris, Gabriele Stocco, Sara De Iudicibus, Sara Marino, Giuliana Decorti, Egidio Barbi, Marco Carrozzi, Federico Marchetti, Fiora Bartoli, Alessandro Ventura

Research output: Contribution to journalArticle

Abstract

A case of severe hypersensitivity syndrome, triggered by carbamazepine in the presence of a concomitant active human herpes virus (HHV) 6 and 7 infection is described. To further understand the molecular mechanism of this adverse reaction, analyses of the genetic variants of human leukocyte antigen (HLA) and of the epoxide hydrolase gene (EPHX1), previously associated with carbamazepine hypersensitivity, were performed. A lymphocyte transformation test (LTT) was conducted in order to detect drug-specific lymphocytes. In the hypersensitive patient, 2 genetic factors previously associated with intolerance to carbamazepine were detected: the allele HLA-A*3101 and homozygosity for the variant allele of SNP rs1051740 in EPHX1. Drug-specific lymphocytes could be detected by LTT when the HHV was active (positive PCR for viral DNA and increased anti-HHV 6 IgG titer), but not when it was no longer active. In conclusion, we document a case of severe carbamazepine hypersensitivity triggered by viral reactivation in a patient presenting the interaction of 2 unfavorable genetic factors.

Original languageEnglish
Pages (from-to)173-177
Number of pages5
JournalInternational Archives of Allergy and Immunology
Volume149
Issue number2
DOIs
Publication statusPublished - May 2009

Fingerprint

Carbamazepine
Hypersensitivity
Viruses
Lymphocyte Activation
HLA Antigens
Alleles
Lymphocytes
Epoxide Hydrolases
Viral DNA
Pharmaceutical Preparations
Single Nucleotide Polymorphism
Immunoglobulin G
Polymerase Chain Reaction
Infection
Genes

Keywords

  • Carbamazepine
  • Epoxide hydrolases
  • Herpesviridae
  • Human leukocyte antigen
  • Hypersensitivity
  • Lymphocyte activation
  • Pharmacogenetics

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Carbamazepine hypersensitivity syndrome triggered by a human herpes virus reactivation in a genetically predisposed patient. / Calligaris, Lorenzo; Stocco, Gabriele; De Iudicibus, Sara; Marino, Sara; Decorti, Giuliana; Barbi, Egidio; Carrozzi, Marco; Marchetti, Federico; Bartoli, Fiora; Ventura, Alessandro.

In: International Archives of Allergy and Immunology, Vol. 149, No. 2, 05.2009, p. 173-177.

Research output: Contribution to journalArticle

Calligaris, Lorenzo ; Stocco, Gabriele ; De Iudicibus, Sara ; Marino, Sara ; Decorti, Giuliana ; Barbi, Egidio ; Carrozzi, Marco ; Marchetti, Federico ; Bartoli, Fiora ; Ventura, Alessandro. / Carbamazepine hypersensitivity syndrome triggered by a human herpes virus reactivation in a genetically predisposed patient. In: International Archives of Allergy and Immunology. 2009 ; Vol. 149, No. 2. pp. 173-177.
@article{521a9999fc6d415ebaf19657f3fe1747,
title = "Carbamazepine hypersensitivity syndrome triggered by a human herpes virus reactivation in a genetically predisposed patient",
abstract = "A case of severe hypersensitivity syndrome, triggered by carbamazepine in the presence of a concomitant active human herpes virus (HHV) 6 and 7 infection is described. To further understand the molecular mechanism of this adverse reaction, analyses of the genetic variants of human leukocyte antigen (HLA) and of the epoxide hydrolase gene (EPHX1), previously associated with carbamazepine hypersensitivity, were performed. A lymphocyte transformation test (LTT) was conducted in order to detect drug-specific lymphocytes. In the hypersensitive patient, 2 genetic factors previously associated with intolerance to carbamazepine were detected: the allele HLA-A*3101 and homozygosity for the variant allele of SNP rs1051740 in EPHX1. Drug-specific lymphocytes could be detected by LTT when the HHV was active (positive PCR for viral DNA and increased anti-HHV 6 IgG titer), but not when it was no longer active. In conclusion, we document a case of severe carbamazepine hypersensitivity triggered by viral reactivation in a patient presenting the interaction of 2 unfavorable genetic factors.",
keywords = "Carbamazepine, Epoxide hydrolases, Herpesviridae, Human leukocyte antigen, Hypersensitivity, Lymphocyte activation, Pharmacogenetics",
author = "Lorenzo Calligaris and Gabriele Stocco and {De Iudicibus}, Sara and Sara Marino and Giuliana Decorti and Egidio Barbi and Marco Carrozzi and Federico Marchetti and Fiora Bartoli and Alessandro Ventura",
year = "2009",
month = "5",
doi = "10.1159/000189202",
language = "English",
volume = "149",
pages = "173--177",
journal = "International Archives of Allergy and Immunology",
issn = "1018-2438",
publisher = "S. Karger AG",
number = "2",

}

TY - JOUR

T1 - Carbamazepine hypersensitivity syndrome triggered by a human herpes virus reactivation in a genetically predisposed patient

AU - Calligaris, Lorenzo

AU - Stocco, Gabriele

AU - De Iudicibus, Sara

AU - Marino, Sara

AU - Decorti, Giuliana

AU - Barbi, Egidio

AU - Carrozzi, Marco

AU - Marchetti, Federico

AU - Bartoli, Fiora

AU - Ventura, Alessandro

PY - 2009/5

Y1 - 2009/5

N2 - A case of severe hypersensitivity syndrome, triggered by carbamazepine in the presence of a concomitant active human herpes virus (HHV) 6 and 7 infection is described. To further understand the molecular mechanism of this adverse reaction, analyses of the genetic variants of human leukocyte antigen (HLA) and of the epoxide hydrolase gene (EPHX1), previously associated with carbamazepine hypersensitivity, were performed. A lymphocyte transformation test (LTT) was conducted in order to detect drug-specific lymphocytes. In the hypersensitive patient, 2 genetic factors previously associated with intolerance to carbamazepine were detected: the allele HLA-A*3101 and homozygosity for the variant allele of SNP rs1051740 in EPHX1. Drug-specific lymphocytes could be detected by LTT when the HHV was active (positive PCR for viral DNA and increased anti-HHV 6 IgG titer), but not when it was no longer active. In conclusion, we document a case of severe carbamazepine hypersensitivity triggered by viral reactivation in a patient presenting the interaction of 2 unfavorable genetic factors.

AB - A case of severe hypersensitivity syndrome, triggered by carbamazepine in the presence of a concomitant active human herpes virus (HHV) 6 and 7 infection is described. To further understand the molecular mechanism of this adverse reaction, analyses of the genetic variants of human leukocyte antigen (HLA) and of the epoxide hydrolase gene (EPHX1), previously associated with carbamazepine hypersensitivity, were performed. A lymphocyte transformation test (LTT) was conducted in order to detect drug-specific lymphocytes. In the hypersensitive patient, 2 genetic factors previously associated with intolerance to carbamazepine were detected: the allele HLA-A*3101 and homozygosity for the variant allele of SNP rs1051740 in EPHX1. Drug-specific lymphocytes could be detected by LTT when the HHV was active (positive PCR for viral DNA and increased anti-HHV 6 IgG titer), but not when it was no longer active. In conclusion, we document a case of severe carbamazepine hypersensitivity triggered by viral reactivation in a patient presenting the interaction of 2 unfavorable genetic factors.

KW - Carbamazepine

KW - Epoxide hydrolases

KW - Herpesviridae

KW - Human leukocyte antigen

KW - Hypersensitivity

KW - Lymphocyte activation

KW - Pharmacogenetics

UR - http://www.scopus.com/inward/record.url?scp=58149142550&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58149142550&partnerID=8YFLogxK

U2 - 10.1159/000189202

DO - 10.1159/000189202

M3 - Article

C2 - 19127076

AN - SCOPUS:58149142550

VL - 149

SP - 173

EP - 177

JO - International Archives of Allergy and Immunology

JF - International Archives of Allergy and Immunology

SN - 1018-2438

IS - 2

ER -